The study aims to investigate the efficacy of extracorporeal CO2 removal for correction of hypercapnia in coronavirus disease 19 (COVID-19)-associated acute respiratory distress syndrome
The prevalence of acute respiratory distress syndrome (ARDS) caused by COVID-19 is
approximately 8%. Lung-protective ventilation is the current standard of care for ARDS. It
limits lung and distal organ impairment, but is associated with hypercapnia in approximately
14% of patients with mild to moderate ARDS and almost all patients with severe ARDS. In this
setting, early implementing of an extracorporeal CO2 removal (ECCO2R) therapy may prevent
further escalation of invasiveness of therapy (eg, need for extracorporeal membrane
oxygenation (ECMO)). A number of low-flow ECCO2R devices are now available and some of those
can be integrated into a renal replacement therapy (RRT) platform. This study aims to
investigate the efficacy of an original ECCO2R system used in conjunction with a RRT platform
in hypercapnic patients with COVID-19-associated mild-to-moderate ARDS with or without acute
kidney injury (AKI) necessitating RRT.
Device: ECCO2R
ECCO2R integrated into the multiFiltrate device
Inclusion Criteria:
- mild-to-moderate ARDS according to the Berlin definition
- lung-protective ventilation with positive end-expiratory pressure (PEEP) > 5 cm of
water on mechanical ventilation expected to last > 24 h
- hypercapnia <80 mmHg
- bilateral opacities on chest imaging
Exclusion Criteria:
- age < 18 years
- pregnancy
- patients with decompensated heart failure or acute coronary syndrome
- respiratory acidosis with persistent partial pressure of blood carbon dioxide (PCO2)
levels >80 mmHg
- acute brain injury
- severe liver insufficiency (Child-Pugh scores > 7) or fulminant hepatic failure
- decision to limit therapeutic interventions
- catheter access to femoral vein or jugular vein impossible
- pneumothorax
University Hospital Giessen and Marburg, Giessen
Giessen, Hessen, Germany
Faeq Husain-Syed, MD
+4964198542351
faeq.husain-syed@innere.med.uni-giessen.de
Istvan Vadasz, MD
+4964198542351
istvan.vadasz@innere.med.uni-giessen.de
Werner Seeger, MD, Study Director
University Hospital Giessen and Marburg, Giessen